Medicaid Expansion Also Expands ER Use

A new report in the New England Journal of Medicine found that Medicaid expansion in Oregon actually increased use of the emergency room (ER) by people newly covered by Medicaid. Policy experts had expected ER use to fall as people gained coverage and could have a usual source of care, such as a primary care physician.  Within the first 15 months after gaining coverage, ER use spiked by about 40%, and remained high for subsequent years. It did not appear the people using the emergency room were necessarily substituting ER visits for primary care physicians (PCP) visits. Rather, PCP visits and ER visits appeared to be complementary.

Mercatus senior research fellow Brian Blase covers the implications in much more detail at Forbes. Blase points out that the value of Medicaid benefits is less than the cost, enrollees are misusing their benefits (ER visits when primary care would suffice). ER overuse makes it harder for those truly in need of emergency care to be seen in a timely manner. It is also arguably why the cost of  Medicaid expansion is far above initial projections.


Comments (6)

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  1. Ron Greiner says:

    How can this be? We spent all of the Obamacare money, that we don’t have, and then we were suppose to get giant stacks of money saved in the ER to drop everybody’s health insurance premiums by $2,500 a year. NOW we will have to raise everybody’s premiums again in 2018.

    I tell you, sometimes I wonder if I should keep trusting President Obama, Hillary and the Democrats.

    Don’t trust lying crooked Hillary / Vote Trump!

  2. Devon Herrick says:

    Ron, don’t hold your breath awaiting your $2,500 savings. Doing so may result in an unexpected ER visit to resuscitate you! In fact, maybe you should bundle up a sack of 2,500 $1 dollar bills (the cost of 1 to 2 ER visits) and send it to the president to fulfill your part to cover the cost of Obamacare.

    Since 2014, my wife’s premiums have risen by at least $2,500 while her deductible has gone up a similar amount. Since her HMO paid almost none of her annual medical bills, she figures she’d probably be better off uninsured.

    • Ron Greiner says:

      Future VP Pence was talking about Obama. — “He compared Obamacare to the Samsung Galaxy 7. I’m not making that up,” said Pence. “You know that cell phone that spontaneously bursts into flames?”

      Pence quoted Obama, “When one of these companies comes out with a new smartphone that has a few bugs, what do they do? They fix it, they upgrade it. Unless it catches fire, then they pull it off the market.”

      “Well Mr. President, that’s exactly what we’re gonna do.”

      “We’re gonna repeal Obamacare lock stock and barrel, we’re gonna pull it off the market,” he continued. “And we’re gonna replace it not with the socialized medicine that Hillary Clinton wants to see.”

      Bill Clinton can now say about Obama’s metaphors – it’s the craziest thing in the world!

      Obamacare is going up in FLAMES like a Samsung Galaxy 7 – Pres. Obama

      Pull Obamacare off the market – Vote Trump/Pence ’16

  3. John Fembup says:

    “Policy experts had expected ER use to fall as people gained coverage and could have a usual source of care, such as a primary care physician.”

    Adequate numbers of physicians do not maintain offices in the poorest sections of cities and in remote rural areas. Doctors are not clamoring for more Medicaid patients, because of its very low reimbursements. The clear majority of the uninsured prior to Obamacare either poor or near-poor.

    Seems to me a spike in ER utilization is perfectly consistent with these facts.

    I wonder by what logic the experts instead persuaded themselves that waves of uninsured people who gained coverage under Obamacare would promptly establish a primary care physician relationship?

  4. Ron Greiner says:

    A new DAR girl is here in TIME for Trump’s Gettysburg address today. Trump told Sean Hannity last night that the 1st 100 days of a Trump Administration includes:

    ‘We’re going to be terminating, repealing and replacing Obamacare. We’re going to be saving our Second Amendment, There are a lot of things, Sean. It’s gonna be – I think it’s gonna be very special.’

    Trump should say about tax-free Health Savings Accounts (HSA) — “Money that is NEVER taxed will last longer in retirement – believe me!”

    Save America – Terminate Obamacare – Vote Trump

  5. Ron Greiner says:

    Medicaid expansion with Obamacare is killing Alaska. Alaska’s Medicaid expansion was initially expected to cost $145 million this year. Even though the number of enrollees roughly matched expectations, the cost of providing them insurance did not. That clocks in at $175 million, a $30 million difference that’s also higher than the Medicaid expansion’s expected cost for all of 2017, too.

    The price of Alaskan oil is dropping like a rock and Medicaid costs are going to the moon. Medicaid already took $640 million from their $5 billion state budget last year — and that was before the expansion. As program spending rises, Alaska will have to do more of what it’s already doing: cutting other services. Alaska is already shutting down or reducing the hours of operation for state courts, and our higher education budget has been substantially reduced.

    Age based tax-credits would make Medicaid spending drop fast. Healthy people would take a higher deductible and have the balance of the age-based tax credit from DC deposited into a tax-free HSA with a mutual fund option.

    Trump’s tax-free HSA deposits will lure poor people off over-priced Medicaid and everybody wins. Tax-free HSA funds used to buy beer only have a 10% penalty after Obamacare repeal. I point out that the little penalty is smaller than Pay-Roll Tax so everything is good.

    Vote Trump